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Maniam P, Bray A, Drinnan M, Fouweather T, Teare MD, Carrie S, O'Hara J. Exploring the Relationships Between Clinical Examination Findings, Subjective Reported Symptoms and Objective Nasal Patency Measures in Nasal Obstruction: A Baseline NAIROS Sub-Study Analysis. Clin Otolaryngol 2024. [PMID: 39245562 DOI: 10.1111/coa.14221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 07/29/2024] [Accepted: 08/23/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND The role of objective nasal airflow measures using peak nasal inspiratory flow (PNIF) and rhinospirometry in supporting clinical examination findings when offering patients septoplasty remain undefined. OBJECTIVE To explore the baseline relationships between clinical examination findings, subjective reported symptoms and objective nasal patency measures in nasal obstruction. METHODS This is a sub-study of the NAIROS trial. Participants with nasal obstruction secondary to septal deviation were included in this NAIROS sub-study. The side of septal deviation, enlargement of inferior turbinate (IT), the need for IT reduction if septoplasty was being performed, the area of septum deflecting into the airway and observer rated airway block (ORAB-arbitrarily divided by <50% and >50% blockage) were assessed by clinicians. The subjective score of nasal obstruction was assessed using the Double Ordinal Assessed Subjective Scale (DOASS). Objective nasal patency measures (e.g., nasal partitioning ratio, [NPR] and PNIF) were measured using PNIF and rhinospirometry. RESULTS The mean NPR for left-sided, both-sided and right-sided septal deviation was -0.35, -0.02 and 0.51, respectively (p < 0.001). There was very weak correlation between the requirement for IT reduction and PNIF change (0.13, p < 0.01). There was no difference in mean PNIF (94 L/min vs. 93 L/min) and mean DOASS (0.33 vs. 0.38) for participants with ORAB rated <50% and >50%. The mean NPR for participants with ORAB >50% was higher than for those with ORAB <50% (0.51 vs. 0.41, p = 0.002). There was strong correlation between the DOASS and NPR (+0.737, p < 0.001). The mean DOASS score for right-sided, both-sided and left-sided septal deviation was 0.32, 0.05 and -0.29, respectively (p < 0.001). CONCLUSION This study identified strong relationships between the clinician rated side of septal deflection, the patient reported DOASS and the objective NPR measurements. NPR and the clinician rated degree of airway blockage were concordant.
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Affiliation(s)
- Pavithran Maniam
- Ear, Nose & Throat Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alison Bray
- Northern Medical Physics and Clinical Engineering, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michael Drinnan
- Northern Medical Physics and Clinical Engineering, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Biostatistics Research Group, Newcastle University, Newcastle upon Tyne, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Biostatistics Research Group, Newcastle University, Newcastle upon Tyne, UK
| | - Sean Carrie
- Ear, Nose & Throat Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James O'Hara
- Ear, Nose & Throat Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Avrunin OG, Nosova YV, Abdelhamid IY, Pavlov SV, Shushliapina NO, Bouhlal NA, Ormanbekova A, Iskakova A, Harasim D. Research Active Posterior Rhinomanometry Tomography Method for Nasal Breathing Determining Violations. SENSORS 2021; 21:s21248508. [PMID: 34960601 PMCID: PMC8708127 DOI: 10.3390/s21248508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 12/11/2022]
Abstract
This study analyzes the existing methods for studying nasal breathing. The aspects of verifying the results of rhinomanometric diagnostics according to the data of spiral computed tomography are considered, and the methodological features of dynamic posterior active rhinomanometry and the main indicators of respiration are also analyzed. The possibilities of testing respiratory olfactory disorders are considered, the analysis of errors in rhinomanometric measurements is carried out. In the conclusions, practical recommendations are given that have been developed for the design and operation of tools for functional diagnostics of nasal breathing disorders. It is advisable, according to the data of dynamic rhinomanometry, to assess the functioning of the nasal valve by the shape of the air flow rate signals during forced breathing and the structures of the soft palate by the residual nasopharyngeal pressure drop. It is imperative to take into account not only the maximum coefficient of aerodynamic nose drag, but also the values of the pressure drop and air flow rate in the area of transition to the turbulent quadratic flow regime. From the point of view of the physiology of the nasal response, it is necessary to look at the dynamic change to the current mode, given the hour of the forced response, so that it will ensure the maximum possible acidity in the legend. When planning functional rhinosurgical operations, it is necessary to apply the calculation method using computed tomography, which makes it possible to predict the functional result of surgery.
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Affiliation(s)
- Oleg G. Avrunin
- Department of Biomedical Engineering, Faculty of Electronic and Biomedical Engineering, National University of Radio Electronics, 61166 Kharkiv, Ukraine; (Y.V.N.); (I.Y.A.)
- Correspondence: (O.G.A.); (D.H.); Tel.: +380-505980086 (O.G.A.); +48-815384313 (D.H.)
| | - Yana V. Nosova
- Department of Biomedical Engineering, Faculty of Electronic and Biomedical Engineering, National University of Radio Electronics, 61166 Kharkiv, Ukraine; (Y.V.N.); (I.Y.A.)
| | - Ibrahim Younouss Abdelhamid
- Department of Biomedical Engineering, Faculty of Electronic and Biomedical Engineering, National University of Radio Electronics, 61166 Kharkiv, Ukraine; (Y.V.N.); (I.Y.A.)
| | - Sergii V. Pavlov
- Department of Biomedical Engineering, Vinnytsia National Technical University, 21021 Vinnytsia, Ukraine;
| | - Natalia O. Shushliapina
- Department of Otorhinolaryngology, Stomatological Faculty, Kharkiv National Medical University, 61022 Kharkiv, Ukraine;
| | - Natalia A. Bouhlal
- Azov Maritime Institute, National University “Odessa Maritime Academy”, 65000 Odessa, Ukraine;
| | - Ainur Ormanbekova
- Faculty of Information Technology, Al-Farabi Kazakh National University, Al-Farabi Avenue 71, Almaty 050040, Kazakhstan;
| | - Aigul Iskakova
- Institute of Automation and Information Technologies, Satbayev University, Satpaev Street 22, Almaty 050000, Kazakhstan;
| | - Damian Harasim
- Faculty of Electrical Engineering and Computer Science, Institute of Electronic and Information Technologies, Lublin University of Technology, 20-618 Lublin, Poland
- Correspondence: (O.G.A.); (D.H.); Tel.: +380-505980086 (O.G.A.); +48-815384313 (D.H.)
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Rennie KJ, O’Hara J, Rousseau N, Stocken D, Howel D, Ternent L, Drinnan M, Bray A, Rooshenas L, Hamilton DW, Steel A, Fouweather T, Hynes AM, Holstein EM, Oluboyede Y, Abouhajar A, Wilson JA, Carrie S. Nasal Airway Obstruction Study (NAIROS): a phase III, open-label, mixed-methods, multicentre randomised controlled trial of septoplasty versus medical management of a septal deviation with nasal obstruction. Trials 2020; 21:179. [PMID: 32054508 PMCID: PMC7020359 DOI: 10.1186/s13063-020-4081-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/16/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Septoplasty (surgery to straighten a deviation in the nasal septum) is a frequently performed operation worldwide, with approximately 250,000 performed annually in the US and 22,000 in the UK. Most septoplasties aim to improve diurnal and nocturnal nasal obstruction. The evidence base for septoplasty clinical effectiveness is hitherto very limited. AIMS To establish, and inform guidance for, the best management strategy for individuals with nasal obstruction associated with a deviated septum. METHODS/DESIGN A multicentre, mixed-methods, open label, randomised controlled trial of septoplasty versus medical management for adults with a deviated septum and a reduced nasal airway. Eligible patients will have septal deflection visible at nasendoscopy and a nasal symptom score ≥ 30 on the NOSE questionnaire. Surgical treatment comprises septoplasty with or without reduction of the inferior nasal turbinate on the anatomically wider side of the nose. Medical management comprises a nasal saline spray followed by a fluorinated steroid spray daily for six months. The recruitment target is 378 patients, recruited from up to 17 sites across Scotland, England and Wales. Randomisation will be on a 1:1 basis, stratified by gender and severity (NOSE score). Participants will be followed up for 12 months post randomisation. The primary outcome measure is the total SNOT-22 score at 6 months. Clinical and economic outcomes will be modelled against baseline severity (NOSE scale) to inform clinical decision-making. The study includes a recruitment enhancement process, and an economic evaluation. DISCUSSION The NAIROS trial will evaluate the clinical effectiveness and cost-effectiveness of septoplasty versus medical management for adults with a deviated septum and symptoms of nasal blockage. Identifying those individuals most likely to benefit from surgery should enable more efficient and effective clinical decision-making, and avoid unnecessary operations where there is low likelihood of patient benefit. TRIAL REGISTRATION EudraCT: 2017-000893-12, ISRCTN: 16168569. Registered on 24 March 2017.
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Affiliation(s)
- Katherine J. Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, NE2 4AE UK
| | - James O’Hara
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
- Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN UK
| | - Nikki Rousseau
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Deborah Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Laura Ternent
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Mike Drinnan
- Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN UK
- Northern Medical Physics and Clinical Engineering, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH UK
| | - Alison Bray
- Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN UK
- Northern Medical Physics and Clinical Engineering, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH UK
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle upon Tyne, NE2 4HH UK
| | - Leila Rooshenas
- Bristol Population Health Science Institute, University of Bristol, Bristol, BS8 2PS UK
| | - David W. Hamilton
- Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN UK
| | - Alison Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, NE2 4AE UK
| | - Tony Fouweather
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Ann-Marie Hynes
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, NE2 4AE UK
| | - Eva-Maria Holstein
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, NE2 4AE UK
| | - Yemi Oluboyede
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Alaa Abouhajar
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, NE2 4AE UK
| | - Janet A. Wilson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
- Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN UK
| | - Sean Carrie
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
- Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN UK
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Kukwa A, Dymek A, Galazka A, Krzeski A, Kukwa W. A new approach to studying the nasal and oral breathing routes. Otolaryngol Pol 2013; 68:112-8. [PMID: 24837905 DOI: 10.1016/j.otpol.2013.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 10/28/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Nasal obstruction is often reported by patients. It is a consequence of a subjective feeling of impaired airflow through the nasal cavity. Currently, objective measures of nasal patency rates are very limited. Functional tests only analyze nasal breathing; they do not simultaneously assess airflow through the mouth. OBJECTIVE The aim of this study is to present a new functional test that assesses a single-stage nasal and oral breathing route. METHODS The NOFA (Nasal-Oral Flow Analyzer) is a three-channel flow meter used to perform continuous and simultaneous measurements of nasal and oral respiratory parameters. We present the application of the device and the proposed study protocol. RESULTS The respiratory tracks of four selected patients are presented. Different breathing patterns are visible: exclusive nasal, exclusive oral, and mixed nasal-oral ventilation pattern. CONCLUSIONS The preliminary results suggest the potential use of the NOFA in ENT practice. Further studies are necessary to evaluate the usefulness of this device in the diagnosis of patients with upper respiratory tract disorders.
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Affiliation(s)
- Andrzej Kukwa
- Department of Otorhinolaryngology, Czerniakowski Hospital, Medical University of Warsaw, Head: prof. dr hab. n. med. Antoni Krzeski, Warsaw, Poland; Department of Otolaryngology and Head and Neck Disease, University of Varmia and Masuria School of Medicine, Head: dr hab. n. med. Anna Doboszyńska, prof. UWM, Olsztyn, Poland
| | | | - Adam Galazka
- Department of Otorhinolaryngology, Czerniakowski Hospital, Medical University of Warsaw, Head: prof. dr hab. n. med. Antoni Krzeski, Warsaw, Poland
| | - Antoni Krzeski
- Department of Otorhinolaryngology, Czerniakowski Hospital, Medical University of Warsaw, Head: prof. dr hab. n. med. Antoni Krzeski, Warsaw, Poland
| | - Wojciech Kukwa
- Department of Otorhinolaryngology, Czerniakowski Hospital, Medical University of Warsaw, Head: prof. dr hab. n. med. Antoni Krzeski, Warsaw, Poland.
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